Healthcare Provider Details

I. General information

NPI: 1225776180
Provider Name (Legal Business Name): MADELINE JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2022
Last Update Date: 07/27/2026
Certification Date: 07/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3130 HIGHLAND AVE
CINCINNATI OH
45219-2399
US

IV. Provider business mailing address

PO BOX 746747
ATLANTA GA
30374-6747
US

V. Phone/Fax

Practice location:
  • Phone: 513-584-4644
  • Fax: 513-584-1559
Mailing address:
  • Phone: 513-232-3332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number57.254995
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.079303
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: